异丙酚联合舒芬太尼或咪达唑仑用于纤维胃镜检查的临床观察  

Clinical analysis of gastrofiberscopy preformed with propofol-sufentanyl or propofol-midazolam

作　　者：张志强[1] 高金贵[1] 安波[1] 

机构地区：[1]河北医科大学第二医院麻醉科,河北石家庄050000

出　　处：《临床荟萃》2007年第4期243-246,共4页Clinical Focus

摘　　要：目的比较异丙酚联合舒芬太尼或咪唑安定麻醉用于纤维胃镜检查的安全性和有效性。方法选择行纤维胃镜检查患者120例,随机分为异丙酚+生理盐水(P组)、异丙酚+咪达唑仑(PM组)、异丙酚+舒芬太尼(PS组)3组;各组在静脉注射异丙酚前分别静脉注射生理盐水2 ml、咪达唑仑0.04 mg/kg、舒芬太尼0.1μg/kg;待患者睫毛反射消失后插入胃镜,检查过程中连续监测心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SpO2),从静脉注射异丙酚开始记录注射部位是否疼痛,睫毛反射消失时间、完全清醒(回答正确、行走自如)时间,术中是否知晓(知道置镜或取镜),术中不适(置镜时咳嗽、屏气、体动),呼吸抑制(暂停、舌后坠),术后是否恶心呕吐,有无头痛、眩晕、恶梦及自我感觉(舒适、无感觉、不适)。结果3组患者均未出现术中知晓、恶心呕吐,亦无恶梦发生;P组异丙酚总用量以及睫毛反射消失时间明显多于PM组和PS组[(316±29)mg vs(240±18)mg、(261±16)mg,(60±14)s vs(45±11)s、(46±10)s,均P<0.05];与术前基础值比较,3组患者术中MAP,术中最低HR、SpO2均明显降低(P<0.05);P组术中最低HR、SpO2明显低于PS和PM组[(73.28±24.33)次/min vs(77.69±15.36)次/min(、76.52±11.24)次/min,(0.81±0.10)vs(0.88±0.78)、(0.88±0.69),均P<0.05];与P组和PS组比较,PM组完全清醒时间明显延长(P<0.05),但P组与PS组间比较差异无统计学意义;PS组的注射部位疼痛发生率(10.0%)明显少于P组(77.5%)和PM组(65.0%)(P<0.01);PS组的术中不适(置镜时咳嗽、体动)发生率(7.5%)亦明显少于P组(32.5%)和PM组(27.5%)(P<0.05);所有患者均无进行气管插管抢救的情况发生。结论异丙酚联合舒芬太尼或咪达唑仑麻醉均能安全有效地用于纤维胃镜的检查,但异丙酚联合舒芬太尼较之异丙酚联合咪唑安定更适合用于纤维胃镜检查的麻醉。Objective To compare efficacy and safety between propofol-sufentanyl and propofol-midazolam for anesthesia of gastrofiberscopy. Methods One hundred and twenty patients scheduled for elective gastrofiberscopy were randomized into three groups： P group as given intravenous normal saline 2 ml before propofol（ n = 40）;PS group as given intravenous sufentanyl 0.1μg/kg then propofol （ n = 40） ;PM group as given intravenous midazolam 0.04 mg/kg then propofol（ n =40）. The gastrofiberscopy was inserted after lash reflex had been extinct. Total dose of propofol, extinction time of lash reflex, heart rate（ HR）, mean arterial pressure （ MAP）, pulse oxygen saturation （SpO2）, time of full recovery （answering correctly and walking unaided）, discomfort, awareness during operation, self-feeling were recorded. Results No nausea, vomiting,nightmare or awareness were noted in all the patients. Total dose of propofol, and extinction time of lash reflex in P group were significantly more than the dose of PM or PS group [（316±29） mg vs （240±18） mg,（261±16） mg,（60±14） s vs （45±11） s,（46±10） s, P〈0.05];no difference proved between PM and PS group; MAP, minimum HR and SpO2 during operation were obviously lower than those preoperation or postoperation in each group, minimum HR and SpO2 during operation in P group were significantly lower than those of P and PM group F（ 73.28 ± 24.33）/min vs （ 77.69 ± 15.36 ）/min, （ 76.52 ± 11.24）/min, （ 0.81 ± 0.10） vs （ 0.88 ± 0.78） ,（0.88±0.69）, P （0. 05]. Time to eye opening in PS group was significantly less than that in P or PM group （ P 〈0.05） ,no difference existed between PM and P group. The patients in PM group and P group reached full recovery obviously slower than those in PS group, no difference between PS and P group. Incidence of pain on injection in PS group（ 10.0 % ） was obviously lower than PM group （ 77.5 % ） or P group （65.0 % ）. Incidence of coughing and moving during operati

关 键 词：胃镜检查 异丙酚 咪达唑仑 舒芬太尼 

分 类 号：R573[医药卫生—消化系统]